Samatha Bagam, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

263259 Issued in NY

Practice address

100 Crystal Run Rd
Suite# 107
Middletown, NY 10941-4041

Phone

(845) 703-6999

Fax

(845) 703-6297

NPI assigned

Apr 25, 2007

Last updated

Jul 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: samatha.bagammd.p1@direct.crystalrun.nextgenshare.com
• Direct secure messaging: sbagam143617@direct.optum.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crystal Run Healthcare Physicians LLP

  • General Practice Physician
  • Middletown, NY
  • NPI 1952376410
  Medicare reassignment NPD
• Crystal Run Healthcare Physicians LLP

  • Durable Medical Equipment & Medical Supplies
  • Monroe, NY
  • NPI 1558857425
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1518186840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CRYSTAL RUN RD",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414028",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CRYSTAL RUN RD",
            "address_2": "SUITE# 107",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414041",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGAM",
        "first_name": "SAMATHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "263259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03111740",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "samatha.bagammd.p1@direct.crystalrun.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 Crystal Run Rd",
            "address_2": "Suite# 107",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109414041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Back in Balance Physical Therapy and Sport Rehabilitation, PLLC
• Kaylin Back, DO
• Linda Bacon, MSED
• Samantha Hope Baer, LMSW
• Melinda Baez
• Christina Bagnati, DO
• Stacy Ann Bailey
• Whitney Hope Baird, PHARM D
• Sonal Bajaj, MD
• Michelle Baker, CCC-SLP

• Pediatrics Physician in Middletown, NY
• Providers in Middletown, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.